Library

When Fire is hyperactive, heat manifests; when Fire is constrained, cold manifests. This is because the Heat-Toxin desires to erupt but cannot, resulting in symptoms that come and go intermittently. These are syndromes presenting with both exterior and interior signs. Throughout the course, Chai Hu (Bupleuri Radix) and Gan Cao (Glycyrrhizae Radix et Rhizoma) should always be used, supplemented by additional herbs tailored to specific symptoms for treatment.

However, distinguishing by the nature of cold and heat: Cold arises due to exterior deficiency allowing pathogenic factors to enter; Heat arises from internal excess. Distinguishing by the stages of onset and resolution: Initially, it is characterized by abundant Toxin attacking and clashing with healthy Qi; during the suppuration stage, Qi and Blood brew pus; after recovery, both Ying (Nutritive) and Wei (Defensive) Qi are deficient. Therefore, isolated fever occurring around the seventh day is termed "Dou Zheng" (Dermal Steaming), indicating that both Qi/Blood and Toxin are abundant. Isolated fever occurring after the fourteenth day is also considered residual Toxin, which is relatively easy to treat. Isolated chills occurring around the seventh day indicate damage to Qi and Blood with internal constraint of Toxin-Fire; this is difficult to treat and requires warming and tonification as the primary method. However, if alternating chills and fever occur between the seventh and eighth days, there is a risk of the lesions sinking inward (Zuo Xian); thus, Ne Tuo San (Internal Support Powder) should be taken frequently to prevent this.

In Shang Han (Cold Damage), males typically present with heavy body weight and sallow complexion, while females present with red face and rapid breathing, aversion to cold and fear of heat, neck stiffness, sour odor in the mouth, undigested milk curds, headache, and body pain; these are all fevers caused by Shang Han. If stool is sour and foul-smelling and undigested, accompanied by abdominal pain, vomiting, diarrhea, belching with foul odor, and aversion to food, this is fever caused by Food Injury (Shang Shi). If the cheeks and malar region are red and dry, frequent sneezing occurs, palpitations and drowsiness are present, hands and feet alternate between cold and hot, sudden convulsions occur during sleep, eyes feel gritty and drowsy, ear tips and the sacrum are cold, chills and fever alternate, yawning and chest oppression occur, cough and palpitations are present, eyelids are swollen and red, feet are slightly cold, or there is unprovoked laughing or crying, red thread-like patterns appear under the skin of the epigastrium, and red vein patterns protrude on the left ear of males and the right ear of females, these are all signs of Dou Chuang (Smallpox). If no rash appears within three days, raw wine should be applied to the body, observing frequently. If the marks resemble flea bites, it is Smallpox. However, many red patterns in the epigastrium indicate severe disease, while few indicate mild disease. If the condition progresses to high fever throughout the body, delirium with hallucinations of ghosts, bleeding from the mouth and nose, and incessant convulsions leading to near-death and revival, this is due to Excess-Heat of Smallpox confined internally. Treatment should focus primarily on promoting the eruption of the rash; once the rash emerges, other symptoms will naturally recede. Regarding fever in Smallpox, the most rapid eruption occurs within one day, the next fastest within three days, and the slowest within five or seven days. By the seventh day, the transmission through the Six Meridians is complete, so the fever ceases here. Fever occurring before the seventh day belongs to miscellaneous diseases, not Smallpox, though it may resemble mosquito or flea bites. Flea bites and mosquito marks are deep red, do not fade upon rubbing, lack subcutaneous nodules, the patient remains quiet, the pulse is not surging, and the spots gradually turn yellow later.